Thoughts on Life and Death

THOUGHTS ON LIFE AND DEATH GUNNAR BIÖRCK, M.D., F.R.C.P.* In the context ofthe First World Meeting on Medical Law I have been asked to introduce the subject oflife and death. These words stand for the two major enigmas ofour existence, the beginning and the end, and they cannot be defined or interpreted fully, or exclusively, in terms ofbiology or law. They carry heavy philosophical, religious, and emotional charges, and whoever attempts to deal with them will beat his forehead bloody against the samewalls thathave, for thousands ofyears, refused to giveway to the attacks ofmetaphysics. For an intelligent discussion ofthis technically difficult and emotionally delicate subject, I think it is unavoidable that each participant tries to define his own background, his frame ofreference, and his values. Only thus will we be able to analyze the more profound, or even submerged, causes of divergent opinions among us and perhaps succeed in finding some common denominators between us. My reflections on the problems of life and death probably should be judged against the fact that Sweden is a Protestant country with widespread religious ignorance and indifference, with generally rather pragmatic attitudes to ethical problems, and with an immature appetite for anything felt to be "progressive." It is, furthermore, a country where capital punishment was abolished in 1921, legal abortion on fairly wide indications introduced in 1938, and clinical trials of "abortion pills" declared lawful by Parliament last year. The removal oforgans for the purpose of transplantation from deceased persons was legally permitted in 1958. Transplantations ofkidneys from both dead and living donors have been performed since 1964. The Swedish physician is not officially requested to take the Hippocratic oath or any of its modern equivalents, * Serafimerlasareltet, Hantverkargatan 2, Stockholm K. Sweden. This is a revision of a paper presented at the First World Meeting on Medical Law in Ghent, Belgium, August, 1967, and is to be included in its Proceedings. 527 although as a voluntary member of the medical association he may feel obliged to adhere to its rules. One ofthese states that the physician shall protect life, from its very beginning in the womb. The official Instruction for Physicians only states that "every patient is entitled to the treatment which his condition deserves and which is in accordance with medical science and established experience." Two recent events in my country have poignantly exposed the problems of euthanasia in a world of modern life-supporting techniques and the demands ofa new surgery which by means oftransplantation ofvital organs tries to make other means ofprolonging life obsolete. In the first instance, the case concerned the cessation ofattempts atprolonging life; in the second, the ambition to secure a transplant from a dying and unconscious patient evoked professional protest. The first case was brought before the lawcourt, where the physician was acquitted of the charge of having shortened the patient's life; the second one was long pending the prosecutor's decision. In the meantime, a special committee within the Royal Medical Board was appointed to examine the prerequisites and consequences of transplantation surgery, and this committee submitted its report in June, 1967. I served as a medical adviser to the Board in both these affairs. However, the thoughts and opinions given in this paper extend considerably beyond such statements as I may have participated in officially, and are my personal responsibility. In a discussion ofthe present kind, I find it necessary to take into account concepts and opinions shared by many people, without regard to their possible verification. In the second case mentioned above, where surgeons had taken a kidney from an unconscious patient with brain damage and transplanted it into another patient, the Attorney General recently resolved that this was a criminal act according to law, but as the physicians' intentions were good, their knowledge of law deficient, and the likelihood of similar acts in the future low, he refrained from accusing the surgeons in question. As for the legal situation in Sweden, so far—and with no leading case as yet established—it seems clear that: (1) death is still defined in the traditional terms of cessation of heart activity and/or of respiration (if cardiac activity has...